April 20, 2011 News Headlines

Message from CMS about the Pre-Existing Condition Insurance Plan (PCIP)

Yesterday, the Centers for Medicare and Medicaid Services (CMS) contacted HANYS with a request to distribute the following message, the first in a series regarding the new Pre-Existing Condition Insurance Plan (PCIP) established by the Affordable Care Act (ACA).

*Please note that New York’s PCIP is the NY Bridge Plan, administered by Group Health Incorporated on behalf of the state.

The PCIP provides a health coverage option for children and adults in all 50 states and the District of Columbia who have been locked out of the health insurance market because of a pre-existing condition. This transitional program will continue until 2014 when Americans, regardless of their health status, will have access to affordable health insurance when the nation transitions to a new marketplace.

To be eligible for coverage under PCIP, applicants must:

Be U.S. citizens or legal residents;

Be uninsured for at least six months;

Have a pre-existing condition or denied health coverage due to a health condition.

For more information and how to apply, go to “Find Your State” at www.pcip.gov and click on your state in the map of the United States or select it in the drop-down menu. You may also call the toll-free line: (866)717-5826 (TTY (866)561-1604). The Call Center is open from 8 a.m. to 11 p.m. Eastern Time. A brochure is also available online that can be printed and distributed: http://www.healthcare.gov/center/brochures/pcip.pdf.

Contact: Danielle Drayer

Proposed Home and Community-Based Services (HCBS) Medicaid Rule

Last week, the Centers for Medicare and Medicaid Services (CMS) issued a proposal that would provide states with greater flexibility in the design and implementation of their 1915(c) Home- and Community-Based Services (HCBS) Medicaid programs for eligible populations defined in §441.301.

Current federal regulations require states to provide programs to meet the needs of the aged and/or disabled, the mentally retarded and/or developmentally disabled, and the mentally ill through a set of individual 1915(c) waivers. The proposed rule, published in the April 14 Federal Register, would enable states to address the needs of these three Medicaid populations with a single combined waiver.

The rule would establish a patient-centered care planning framework to facilitate the coordination of services for all eligible populations, including eligible recipients in the same family. It would allow HCBS care to be provided in “alternative settings,” excluding those co-located in inpatient institutions, adjacent to public facilities, in housing designed around an individual’s diagnosis or disability, or in settings with “qualities of an institutional setting” as determined by the Secretary. CMS also sets forth state compliance guidelines and parameters for amending HCBS waivers in its proposal.

HANYS is reviewing the rule and will prepare comments on behalf of its members before the June 14 deadline.